Epidemiological, clinical, and histological characteristics of intestinal metaplasia at the oesophagogastric junction compared to short segments of columnar-lined oesophagus

Objective Intestinal metaplasia (IM) close to the oesophagogastric junction (OGJ) has become a focus of research interest against a background of the rising incidence of malignancies in that area. Studies have focused on the presence of IM in short columnar segments (0-3 cm). Recently it has been su ggested that IM at the OGJ and IM in short columnar segments may represent different entities. The objective of this current study was to determine th e prevalence of IM in these areas and to assess clinical characteristics in order to test the hypothesis that IM at the OGJ and IM in short columnar s egments are different entities. Methods Six hundred and fifty-eight patients referred for gastroscopy, in w hom a columnar lining of 0-3 cm was found, participated in the study. Endos copic oesophagitis was graded, distances to endoscopic landmarks; were meas ured, and biopsies (antrum, corpus, 'cardia', and immediately distal to the squamocolumnar junction) were taken. Biopsies were stained with haematoxyl in & eosin, Alcian Blue (pH 2.5), modified Giemsa for Helicobacter pylori ( Hp), and immunohistochemistry in cases of a negative Giemsa. According to e ndoscopy, patients were categorized as having a normal OGJ (0-1 cm) or havi ng a short columnar segment (1-3 cm, tongues >1 cm). Results In this study 77.7% of patients had a normal OGJ (IM-positive 15.1% ), and 22.3% had a short columnar segment (IM-positive 29.3%). In the first group, IM was correlated with Hp (P = 0.003) and antral IM (P = 0.002), in the second IM was associated with the presence of a hiatal hernia (P < 0.0 01) and reflux oesophagitis (P = 0.023). Conclusion These findings suggest that IM at the OGJ is not the same entity as IM in short columnar segments. Eur J Gastroenterol Hepatol 13:113-120 ( C) 2001 Lippincott Williams & Wilkins.